拱形椎弓根螺钉钢板内固定治疗腰椎爆裂型骨折69例

Treatment of the Lumbar Burst Fractures by Fixing the Arched Pedicle Screw Plate(Report of 69 Cases)

目的 探讨腰椎爆裂骨折的治疗方法。方法 采用Steffee钢板折弯成 2 0°～ 30°拱形 (弧形 ) ,利用拱形钢板与脊柱后凸畸形之间凸面的失偶现象产生折顶过伸复位与内固定 ,同时采取腰椎板两侧开窗减压和“夹心式”加压植骨。结果 完成 6 9例 ,随访 1～ 7年 ,平均 3 3年 ,术前椎体前缘高度平均 5 7 2 % ,术后 2周平均 91 4% ,手术一年后平均 85 7% ;术前椎体后缘高度平均 73 8% ,术后 2周平均 97 2 % ,手术一年后平均 88 1%。Cobb角术前上腰椎 (L1-3)平均 2 3° ,术后平均 6°;下腰椎 (L4 ,5)术前平均 2° ,术后腰椎生理前凸平均恢复为 18°。神经损伤在下腰椎骨折的病例中恢复较好。结论 拱形椎弓根钢板对脊椎后柱产生过伸折顶复位的力学支点 ,使三柱产生均匀的前凸撑开 ,降低了前柱和中柱对螺钉的压缩负荷。开窗减压减少腰椎后部结构的损伤 ,夹心式加压植骨提高了脊柱融合的质量。术后短期内椎体平均高度矫正满意 ,钢板疲劳变形与内固定松动是导致术后远期椎体高度丢失的主要原因。

Objective To find the way for treatment of the burst fractures of lumbar vertebra Methods Using Steffee steel plate bent to arched 20°～30° Making the arch pedicle screw plate aganist kyplotic deformity of lumbar spine fracture that osteoclastic reduction and internal fixation take place Meanwhile bilateral fenestration reducing pressure for spinal canal and pressed sandwich grafts were adopted Results Sixty-nine cases were followed-up for one to seven years The average heigh of the preoperative vertebra body anterior border is 57 2% Two weeks after operation is 91 4%,one year after operation is 85 7% The average height of the preoperative verteberal body posterior border is 73 8% Two weeks after operation the average height is 97 2%,and 88 1% one year after operation The average Cobb′s angle of the superior lumbar vertebra(L 1-3 )before operation is 23° The average angle is 6°after operation The average angle of the lower lumbar vertebra(L 4,5 )is 2° before operation,after operation the lumbar physiologic lordosis is 18° Neural function in this cases of the lower lumbar spine injures has been restored better Conclusion The arched pedicle screw plate caused the mechanics supporting point which has been stretched and bent for dislocation reduction and provided symmetric three-column lordotic distraction,reduced the pressed load to the screw from the frant and middle columns The fenestration reducing pressure lessened the injure from the posterior structure of the lumbar vertebra The pressed sandwich grafts increased the quality of spinal fusion After operation the corrected average vertebral height is satisfactory in the short term The shape-change of plate due to metal fatigue and loosing of the fixed screw caused the loss of the vertebral height in the long term after operation